scholarly journals Methods and Results of the Brain and Visceral Organs Protection During the Correction of the Ascending Aorta and Aortic Arch Aneurysm or Isolated Aortic Arch Aneurism

2021 ◽  
pp. 75-81
Author(s):  
V. I. Kravchenko ◽  
I. M. Kravchenko ◽  
I. I. Zhekov ◽  
V. D. Lybavka ◽  
V. V. Lazoryshynets
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Median Sternotomy ◽  
Ascending Aorta ◽  
Aortic Arch Aneurysm ◽  
Elephant Trunk ◽  
Bentall Operation ◽  
Visceral Organs ◽  
Arch Aneurysm ◽  
The Brain

The ascending aorta and aortic arch aneurysm surgical correction is the most difficult problem of cardiovascular surgery due to the necessity of management of the main disease and adequate protection of the brain and visceral organs. The aim. To present the methods and results of protection of the central nervous system and visceral organs during the correction of the ascending aorta and aortic arch aneurysm or isolated aortic arch aneurism. Materials and methods. During 1994–2018, we operated 419 patients with the ascending aorta and aortic arch aneurysm (or isolated aortic arch aneurism). Diagnosis of aneurysms was based on clinical data, transthoracic and transesophageal echocardiography, computed tomography, X-ray examination, aortography. All operations were performed under general anesthesia, through the median sternotomy using cardiopulmonary bypass. Valve-sparing technique with aortic valve resuspension/aortic valve plasty and semi-arch/arch replacement was used in 288/9 (68.7%) patients. Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%) patients. Other operations accounted for 45 (10.7%) patients. Results. The history of the development of aortic aneurysms treatment options is briefly overviewed in the paper. Diagnostic methods are mentioned, but the main method today is computed tomography. Initial status of the patients was severe. All operations were performed through median sternotomy using cardiopulmonary bypass. The following techniques were used for surgical treatment of aneurysms: 1) valve-sparing technique with aortic valve resuspension/ plasty and semi-arc/arch replacement was used in 288/9 (68.7%) patients. In this group there were 8 Yacoub operations, 6 David operations. In 7 patients, plication of one of the leaflets was performed in case of aortic valve prolapse. 3 patients underwent strengthening of the free edge of the leaflets and 4 patients underwent plasty by the patch in case of leaflet fenestrations; 2) Bentall operation with semi-arch/arch replacement was used in 86/9 (20.5%); 3) others: isolated arch in 15 (3.6%); Wheat operation + arch in 9 (1.0%); aortic arch plasty in 4 (1.0%); Elephant trunk (conventional Elephant trunk) + TEVAR was used in 17 (4.1%) patients. The brain protection was performed differently at each of the two stages in our surgical experience. The best result was achieved at the last stage. The number of postoperative complications decreased from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%, respectively. Also, a modern endovascular method – hybrid operations Elephant trunk + TEVAR – was used in 17 (4.1%) patients with good immediate result. Conclusions. 1. At type A aortic dissection (DeBakey type I) the operation of choice is supracoronary ascending aortic replacement with a semi-arch (arch) replacement of the aorta. 2. Accumulation of surgical experience, team training, improvement of methods of protection of the brain and visceral organs allowed to reduce the number of postoperative complications from 34.4% to 8.4% and hospital mortality from 17.2% to 5.3%.

scholarly journals 506 Uneventful pseudoaneurysm of the ascending aorta with sternal erosion in pregnancy

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N142-N145
Author(s):  
Alice Benedetti ◽  
Alvise Del Monte ◽  
Maurizio Rubino ◽  
Daniela Mancuso
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Arch Aneurysm ◽  
Elective Cesarean Section ◽  
Elephant Trunk ◽  
Severe Aortic Regurgitation ◽  
Intimal Flap ◽  
Arch Aneurysm

Abstract A 36-year-old woman at 31 weeks’ gestation presented with exertional dyspnoea and palpitations. She had a history of bicuspid aortic valve treated with surgical aortic valvotomy for severe stenosis, followed by ascending aorta replacement for type A acute aortic dissection and Bentall operation with a mechanical valve for severe aortic regurgitation. Eight years after the last surgery, magnetic resonance angiography showed aortic arch aneurysm (49 mm) with a small intimal flap. Thereafter, the patient was lost to follow-up until the current admission. She was hemodynamically stable on presentation and physical examination was unremarkable apart from a mechanical second heart sound. The electrocardiogram showed sinus rhythm with left bundle branch block (Panel A). Transthoracic echocardiography revealed severe left ventricular dilation (EDV 90 ml/m2) with mild dysfunction (EF 50%), normal prosthetic aortic valve function, and aortic arch dilation (50 mm) (Panel B and C). After a multidisciplinary evaluation, elective cesarean section was performed at 34 weeks’ gestation. A post-delivery aortic computed tomography angiography revealed aortic arch aneurysm (52 mm) with intimal flap and two pseudoaneurysms of the anterior aortic wall causing sternal erosion (Panel D, E, F and G). Subsequently, the patient underwent ascending aorta and aortic arch replacement by Frozen Elephant Trunk technique with a 24 x130 mm prosthesis between the aortic root and the descending aorta. The postoperative course was uneventful, and the patient was discharged to a cardiac rehabilitation centre.

Midterm results for endovascular stent grafts via median sternotomy for distal aortic arch aneurysm

2006 ◽  
Vol 9 (3) ◽  
pp. 149-153 ◽  
Author(s):  
Koji Sakurai ◽  
Akihiko Usui ◽  
Yuuichi Ueda ◽  
Toshiaki Akita ◽  
Masaharu Yoshikawa ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Median Sternotomy ◽  
Aortic Arch Aneurysm ◽  
Endovascular Stent ◽  
Stent Grafts ◽  
Midterm Results ◽  
Distal Aortic Arch Aneurysm ◽  
Arch Aneurysm

Reoperations for Aneurysmal Disease of the Ascending Aorta, Aortic Arch, and Descending Aorta: Their Causes and Operative Results

1994 ◽  
Vol 2 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Shigeaki Aoyagi ◽  
Hidetoshi Akashi ◽  
Keiichiro Tayama ◽  
Yuji Hanamoto ◽  
Kazunari Yamana ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Ascending Aorta ◽  
Aortic Arch Aneurysm ◽  
Definitive Treatment ◽  
Initial Operation ◽  
Annuloaortic Ectasia ◽  
Pseudoaneurysm Formation ◽  
Aortic Pathology ◽  
Arch Aneurysm

Between 1984 and 1993, 20 patients underwent reoperation for the thoracic aorta or ascending aorta and aortic valve. There were 14 male and 6 female patients who ranged in age from 28 to 70 years with a mean of 53.2 years. The mean interval between initial operation and the 2nd operation was 70.4 months. Of the 20 patients, 6 had stigmata of Marfan's syndrome. The primary aortic pathology requiring initial operation was annuloaortic ectasia in 10 patients, aortic valvular disease in 5, aortic dissection in 3, and mega aorta syndrome, aortic aneurysm in multiple segments, or aortic arch aneurysm in 1 each. Cause of reoperation was pseudoaneurysm formation at suture lines in the ascending aorta in 6 patients, new or progressive dilatation in the remaining aortic segment in 5, new or persistent aortic dissection in 4, graft infection in 2, and recurrent aortic arch aneurysm in 1. The remaining 2 patients received a planned two-stage operation for multiple aneurysms or mega aorta syndrome. Six patients died early after reoperation, yielding a hospital mortality rate of 30%; however, 3 of the 6 deaths were related to a compromised preoperative clinical condition and 1 to perioperative contamination. Two operative deaths (10%) were related to operative techniques. Results suggest application of separate grafts for coronary artery reattachment, as in the Cabrol or Piehler techniques, or the aortic button technique for aortic root replacement, may help eliminate pseudoaneurysm formation, which is one of the major complications after operations on the ascending aorta. It is also suggested that early diagnosis and prompt operative treatment for recurrent or residual aneurysmal diseases of the aorta may be essential for successful definitive treatment.

scholarly journals Contained rupture of arch aneurysm managed with total arch, frozen elephant trunk and endograft

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
Michael Ibrahim ◽  
Roland Assi ◽  
Fenton McCarthy ◽  
Michael A Golden ◽  
Wilson Y Szeto
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Stent Graft ◽  
Thoracic Aortic Aneurysm ◽  
Aortic Arch Aneurysm ◽  
Distal Anastomosis ◽  
Complex Case ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Arch Aneurysm

We here describe a complex case of a 75-year-old man presenting with contained rupture of an aortic arch aneurysm in the presence of a second thoracic aortic aneurysm. He was managed with emergent total arch replacement with frozen elephant trunk. Another stent-graft was used to achieve hemostasis at the distal anastomosis. He later underwent TEVAR extension to manage his second aneurysm in a staged fashion. This case demonstrates a number of important concepts in the evolving interaction between open and endovascular therapies of the aortic arch, particularly in the emergent setting.

scholarly journals A New Aortic Arch Inclusion Technique with Frozen Elephant Trunk for Aortic Arch Aneurysm Treatment

2020 ◽  
Vol 61 (6) ◽  
pp. 1229-1235
Author(s):  
Cuilin Zhu ◽  
Hulin Piao ◽  
Yong Wang ◽  
Bo Li ◽  
Yixin Zhang ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Arch Aneurysm ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aneurysm Treatment ◽  
Arch Aneurysm
Sign in / Sign up

Export Citation Format

Share Document